How does the process to claim under COIDA work?

When dealing work related accidents, there still seems to be a lot of uncertainty relating to the correct reporting and recording procedures of work related injuries. The Compensation for Occupational Injuries and Diseases Act, Act 130 of 1993 (“COIDA”) is the governing Act in South Africa that deals with occupational injuries and diseases.

The aim of COIDA is to provide for compensation in the case of disablement caused by occupational injuries or diseases, sustained or contracted by employees in the course of their employment, or death resulting from such injuries or disease; and to provide for matters connected therewith. COIDA prevents employees covered by the Act from suing their employers for damages in terms of common law.

Any employer with one or more employees must register with the Compensation Fund and pay annual assessment fees. Claims for employees employed in the mining and building industries must be referred to the relevant mutual associations. Claims by employees working for individually liable employers such as the state, parliament, the provincial authorities and local authorities – which have been exempted from making payments to the compensation fund – must be referred to the employer. The following steps, as set out below, should be followed when reporting to and claiming from the Compensation Fund in terms of COIDA:

The accident must be reported when an employee injures himself or herself, out of and in the course of employment resulting in a personal injury for which medical treatment is required.

Written or verbal notice of an injury at work is to be given to the employer before the completion of the shift or end of the workday. Good practice on the side of the employer will be to make a list of all witnesses of the accident for the further investigation of the incident. An official form needs to be completed – known as the “W.Cl 2 Form – Notice of Accident and Claim for Compensation”. This form should be completed whenever an employee has an accident out of or in the course of employment leading to personal injury, medical treatment or death. It is the employer’s duty to submit the W.Cl 2 form, within a period of 7 days after the accident to the Compensation Commissioner.

After the completion of the form, the employer must send the form with a certified copy of the employees identity document and the first medical report (“W.Cl 4 form”) to Compensation Commissioner. A medical practitioner should complete the W.Cl 4 form, stating the seriousness of the injury, as well as the time period the employee is likely to be absent from work. Once completed, the medical practitioner sends it to the employer who forwards same to the Commissioner. Employees are not responsible for the payment of medical costs in this regard, however, if an employee requests a second medical practitioner’s opinion, he/she will be liable for the payment of medical costs.

After the Compensation Commissioner receives the abovementioned documents, he/she will then register the claim and forward a postcard (“W.Cl.55”) to the employer. A claim number is provided on the postcard and this number should be used for all paperwork relating to a claim. When the first doctor’s report has been submitted with the accident report, the Compensation Commissioner will consider the claim and make a decision.

After the Compensation Commissioner has considered the claim a postcard (“W.Cl.56”) will be sent to the employer. The W.Cl.56 postcard, will only be used by the Compensation Commissioner when liability is accepted for payment of the claim. Where a W.Cl.56 is not issued, it usually indicates that the Compensation Commissioner has not accepted liability for any payment – in this instance the employee may have a claim against the employer. If the employee, however, disagrees with the decision of the Compensation Commissioner, an appeal may be lodged by the employee within 90 days by submitting form “W929” to the Compensation Commissioners’ office.

If the work-related injury continues for a long time and where the employee is prolonged absent from work, the medical practitioner must send a progress medical report (“W.Cl 5”) to the Compensation Commissioner. The progress report should be submitted monthly until the employee’s condition is fully stabilised. This informs the Compensation Commissioner of the time period the employee is absent work.

Once the medical practitioner handling the case is satisfied that the employee is fit to return to work, the practitioner will issue a final report that the employee is fit to return to work; or that the employee’s injury resulted in him/her being permanently disabled. The medical practitioner must forward this report to the employer who will sends it to the Compensation Commissioner.

When the employee resumes work, a resumption report (“W.Cl 6”) must be completed and submitted to the Compensation Commissioner. Only after every one of these forms has been submitted to the Compensation Commissioner, will payment be made of all of the medical and related disbursements, where after the case will be closed.

This article is a general information sheet and should not be used or relied on as legal or other professional advice. No liability can be accepted for any errors or omissions nor for any loss or damage arising from reliance upon any information herein. Always contact your legal adviser for specific and detailed advice. Errors and omissions excepted (E&OE)

Reference List:

The Compensation for Occupational Injuries and Diseases Act, Act 130 of 1993